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Sexually Transmitted Diseases

Sexually Transmitted Diseases

What Are Sexually Transmitted Diseases?

Lower genital tract infections constitute the most common group of diseases that cause gynecological complaints. A significant number of these infections can be transmitted sexually in women without symptoms. These infections can lead to the disease as affecting the vulva, vagina, cervix and intrauterine membrane in the woman

While sexually transmitted diseases cause ulcerated, red, itchy lesions of the vulva in some of women, in others they induce gynecological complaints such as discharge and pain by involving the vagina and cervix.

The spread of microorganisms from the cervix to the internal genital organs leads to a disease called pelvic inflammatory disease (PID). Infections of the upper urogenital tract can be caused by many bacteria, especially Neisseria gonorrhea and Chlamydia trachomatis.

Sexually transmitted infections include:

  1. Genital Warts (Human Papilloma Virus, HPV)
  2. Scabies
  3. Molluscum Contagiosum
  4. Pediculosis pubis (pubic lice)
  5. Genital Herpes (HSV)
  6. Syphilis
  7. Bacterial Vaginitis
  8. Trichomoniasis (Trichomonas vaginalis)
  9. Fungal Infections
  10. Chlamydia
  11. Gonorrhea
  12. Mycoplasma and Ureplasma
  13. Hepatitis B and C
  14. HIV

1. Genital Warts (Human Papilloma Virus, HPV)

Human Papilloma Virus (HPV) is a sexually transmitted viral infection that is common in the community. Most HPV infections heal spontaneously without symptoms. However, some of them cause warts in the female genital area. Genital warts are cauliflower-like, raised and soft lesions from the skin.

The most common cause of genital warts is HPV types 6 and 11. These viruses induce skin lesions in the genital area called Conduloma Acuminata. Lesions may take form on different numbers and sizes on the skin of the vaginal mucosa or genital area.

Some types of HPV also pose a risk for cervical cancer. HPV types 16, 18, 31 and 45 play an important role in the development of cervical cancer. These types of HPV entail a high risk of cervical cancer.

The incidence of HPV peaks between the ages of 15 and 25, which is the sexually active period. It is possible to diagnose most warts visually. The HPV test is used to determine which virus types the woman is infected with.

Novadays, 9-valent HPV vaccine is injected to protect against HPV. This vaccine is administered intramuscularly (IM) as 2 doses in the form of 0, 6 months in the age range of 9-14 years and as 3 doses in the form of 0, 2, 6 months in the age range of 15-46 years. 9-valent HPV vaccine is protective against types 6, 11, 16, 18, 31, 33, 45, 52, 58. In addition, partial protection against other types can be provided by cross-reactivity.

Topical medications, surgical excision, cauterization, cryotherapy or wart freezing are used in the treatment. The lesions may regress spontaneously. But no method of treatment completely removes the virus from the body. The choice of treatment is made according to the number, size and location of the lesion.

2. Scabies

Scabies is a parasitic organism that can be seen all over the body as well as settle in the genital area. The causative agent of scabies is Sarcoptes scabies hominis - a mite belonging to the group of small arthropods. This mite settles in the upper layer of the skin and moves forward while making tunnels.

It can be transmitted sexually as well as through clothes, towels and bed linen. Prolonged contact is required to infect with it. Some types of scabies are highly contagious. In people with weak immune systems, the disease may be aggressive.

The most important symptom of the disease is intermittent attacks of severe itching. Itching occurs after 3-5 weeks following the infection of scabies. Itching increases at night and after hot baths. There may be a widespread itching all over the body.

1-10 mm sized, white-gray lined skin lesions are seen in regions where mites exist, particularly areas in between fingers. These lines are tunnels that the mite digs in the skin. Also, there is redness, rash and fluid-filled lesions on the skin.

The diagnosis is made by skin manifestations and visual appearance of the mite. In the treatment, drugs that kill both the mite and the eggs of the mite are used, as well as antihistamine drugs for itching.

3. Molluscum Contagiosum

Molluscum Contagiosum is a skin disease caused by poxvirus. It is an infection characterized by raised lesions on the skin with a diameter of 2-5 mm, pitted in the middle.

It is transmitted by skin contact and the use of mutual items. If a person touches the lesion on her/his skin, she/he can transmit to another part of body. The lesions appear in weeks after the virus has infected the skin. The disease is usually self-limiting. By the typical appearance of lesions, the disease can be diagnosed. In suspicious cases, microscopic examination is performed.

In the treatment, freezing, cauterization, laser ablation or drain of the white viscous contents in the lesion by curettage is applied. The disease can be followed for a while because it is self-limiting.

4. Pediculosis pubis (pubic lice)

Pediculosis Pubis occurs with an ectoparasite, Phthirus Pubis. Their appearance is similar to crab. Ectoparasites are parasites that survive by attaching to the outer part of the host's body. It is usually located in the genital and perianal region. Rarely, the disease can be seen in other parts of the body.

Pubic lice are most often transmitted by sexual contact. The parasite leaves its eggs inside the hair follicle. These eggs grow by hatching in 7-10 days. Removing these eggs from the skin is important in treatment. Parasites live by clinging to the hair follicles. Parasite feeding with blood can remain viable during 1.5 months. Pubic lice are smaller than other body lice.

The most important symptom of pubic lice is severe itching. Symptoms such as redness and swelling appear on the skin where the louse bites. In the case of many lesions, there may be systemic findings like weakness, mild fever and irritability.

The disease is diagnosed by the visual appearance of larvae and eggs. In the treatment of pubic lice, cleaning of parasites and eggs, various creams, shampoos and lotions are utilized.

5. Genital Herpes (HSV)

Herpes Simplex Virus (HSV) is a sexually transmitted disease that causes ulcers of the genital area. HSV is responsible for most infection-related genital ulcers.

There are many types of this virus. However, HSV type 2 infection is the most common in the genital area and less rarely HSV type 1 infection. Infections with HSV type 2 are more contagious.

Symptoms appear 7-10 days after the virus is infected. However, most patients do not have any symptoms. The virus can remain in the body for years without symptoms after transmission. The virus becomes active when the immune system is weakened or when there is severe stress.

The disease usually heals within 1-3 weeks, limiting itself. On the skin, painful, fluid-filled blisters, ulcers and crusts are observed. There may be symptoms such as inguinal enlarged lymph nodes, asthenia and fever.

Genital herpes usually begins with itching in the vulva area. Later, multiple fluid-filled vesicles emerge. The vesicles turn into painful ulcers by merging. During this period, the disease is highly contagious. However, even if there are no symptoms, genital herpes is an infectious disease.

The disease is diagnosed by the appearance of painful lesions. In suspicious cases, the disease is diagnosed by detecting virus antibodies and incubating the virus in culture. Systemic antiviral therapy reduces the severity of the disease and prevents complications.

Despite treatment, the virus cannot be completely eradicated. In the nerve roots in the area of the sacrum, the virus remains in a latent form. There is no vaccine for the disease yet. Women who have an infection for the first time in their pregnancy should be treated. The virus can be transmitted to the baby during vaginal birth. Therefore, caesarean section is preferred in women with genital HSV.

6. Syphilis

Syphilis is mainly a sexually transmitted disease. It is a motile, helical, spiral-shaped bacterium whose causative agent is Treponema Pallidum. T. pallidum causes the formation of painless ulsers called chancres in the genital area, mouth and anus. The disease is transmitted by contact with lesions of the skin and mucous membranes, secretion of semen and vagina.

Syphilis disease consists of 4 stages: primary, secondary, latent and tertiary. The contagiousness of the disease is quite high in the first year. Infectivity gradually decreases towards the end of the fourth year.

Primary syphilis occurs with a single painless lesion that occurs on the vulva, vagina and cervix. The chancre lesion is painless, hard and raised from the skin. Over time, it ulcerates and becomes pitted in the middle. There may be discharge in the lesion. Often there are enlarged  inguinal lymph nodes. If this lesion is not treated, it disappears within 3-6 weeks.

Secondary syphilis develops as a result of the spread of bacteria through the blood. In this stage, there is a itchyless, raised,exanthematous typical rash on the whole body, especially seen on the palms and soles. Enlarged lymph nodes fever, weakness, throat, joint pains and headache may be experienced.

Latent syphilis is the third stage in which the disease hides and its symptoms disappear. Antibodies to the disease are positive in the blood. The disease is not transmitted by sexual contact during this period. The latent period lasts about 4 years. But at this stage, the bacteria can pass from mother to baby. The baby can get the disease in the womb or during birth at the stage of genital lesions.

Tertiary syphilis occurs months or years after the initial infection. End-stage disease is seen in 30-35% of people who have been treated or partially treated. The main organs that the disease affects at this stage are:

  • Skin
  • Bones and joints,
  • Cardiovascular system,
  • Eye and Brain,
  • Liver.

Aortic aneurysm and aortic valve insufficiency are seen in cardiovascular involvement. Internal organ damage caused by the disease is progressive and fatal. Tissue necrosis areas called gumma (gom) appear in the organs.

In the treatment of syphilis, antibiotics determined their dose and duration according to disease level  are used. Especially penicillin group antibiotics are preferred in the treatment. Clinical follow-up of the patients for one year is performed and serological tests are examined.

In patients with genital ulcers excluded from the diagnosis of syphilis, other bacterial infections such as Granuloma Inguinale (Klebsiella granulomatosis),Lymphogranuloma Venerum (Chlamydia trachomatis) and Chancroid (Haemophilus ducreyi) should be considered.

7. Bacterial Vaginitis

The most common reason of vaginal infections is bacterial vaginitis. Bacterial vaginal infections are not usually sexually transmitted. However, if there is pregnancy, it poses a risk for premature labor. Vaginal infections often give symptoms such as foul-smelling discharge, itching, burning and pain in the vagina.

In the normal vaginal flora there are many organisms, such as lactobacilli and candida. These organisms maintain a normal pH of the vagina. The normal pH of the vagina varies between 3.8-4.2. It is lactobacilli that produce hydrogen peroxide that keep the vagina at this acidic pH value.

When the normal pH of the vagina is disturbed, the balance of flora is destroyed as well. Bacterial vaginal infections mostly are induced by Gardnerella vaginalis. Gardneralla vaginalis is a bacterium that exists in normal vaginal flora.

Normal vaginal discharge is transparent, whitish and odorless. A discharge that is dark yellow, green, brown or gray and bad smelling is a sign of infection. Oral tablets, vaginal ovules, creams, and gels containing antibiotics are used in the treatment.

8. Trichomoniasis (Trichomonas vaginalis)

Trichomonas vaginalis is a unicellular protozoa. It is sexually transmitted in women and lead to vaginal infections. Contamination can also occur from damp towels, toiletries, toilets or surfaces.

Symptoms of trichomonas vaginitis include:

  • Yellow-green colored, foul-smelling vaginal discharge,
  • Itch
  • Redness in the vagina and cervix,
  • Pain during sexual intercourse,
  • Pain in the lower abdomen,
  • Burning while urinating.

In the treatment, appropriate antibiotics are used. In this disease, co-treatment is also necessary. Sexual intercourse should be avoided until treatment is finished and symptoms regress.

9. Fungal Infections

The causative agent of most vaginal yeast infections in women (80-90%) is Candida albican. This fungus is normally part of the vaginal flora. In fact, it is not a sexually transmitted disease. But other diseases that are transmitted sexually and disrupt the vaginal flora lead to the reproduction of this fungus.

75-80% of women have had a vaginal yeast infection at certain times in their lives. Complicated and recurrent fungal infections are seen in 5% of women. Most recurrent infections are caused by a different type of Candida.

The use of antibiotics, diabetes, pregnancy, weakening of the immune system, unhealthy diet, hormonal irregularity, birth control pills, hormone treatments and stress disrupt the vaginal flora and lead to the development of fungus.

Symptoms of vaginal yeast include:

  • Intense itching in the vagina and vulva,
  • Redness, edema and rash around the vagina,
  • White, dense, cheeselike vaginal discharge
  • Burning while urinating,
  • Pain during sexual intercourse.

Cotton, non-tight underwear and clothes should be preferred to protect against vaginal fungi. It is necessary to pay attention to the cleanliness of the genital area. The genital area should not be left moist. Unnecessary use of antibiotics should be avoided. Jacuzzi, hammam, sauna and bathtub cause excessive hot water ingress into the vagina, increase the risk of fungus development.  Soaps, tampons and pads including perfume should not be preferred.

The disease can be diagnosed by clinical history and gynecological examination. If necessary, the diagnosis is supported with various tests and samples. In the treatment, creams, tablets, suppositories applied into the vagina and oral antifungal drugs are used.

10. Chlamydia

Chlamydia trachomatis is the most common infection caused by sexually transmitted bacteria. This disease causes a hemorrhagic infection when it touches the cervix. This finding, together with cervical discharge, provide to diagnose the disease.

This bacterium can survive by invading to the cell. It infects by attaching to the cells in the transition area of the cervix.

70-80% of chlamydia infections do not cause symptoms. The most important symptoms of this disease are;

  • Abnormal vaginal discharge,
  • Vaginal bleeding in the form of spotting,
  • Blood coming after intercourse,
  • Burning while urinating.

The discharge usually has a yellow- green colored,  inflamed appearance. If there is bleeding, its color may darken. To diagnose the disease, a PCR (polymerase chain reaction) test is performed by taking a sample from the discharge in the cervix. Cell culture is not preferred because of the high rate of false positivity. Appropriate oral antibiotics are used for the causative agent in the treatment. At the same time, spousal treatment should be given.

11. Gonorrhea

Neisseria gonorrhea is a sexually transmitted bacterial infection. It causes the infection as settling in the cervix. It most often infects the inner part of the cervix. About 50-60% of patients do not show symptoms. The most common symptoms are;

  • Vaginal discharge,
  • Burning while urinating,
  • Abnormal uterine bleeding.

Culture and PCR test can be used in diagnosis. Appropriate oral antibiotics are preferred in the treatment. In resistant cases, antibiotic sensitivity tests can be performed according to culture. It should be reminded that the disease can be observed together with chlamydia. In this case, the treatment of both microorganisms  is planned together.

12. Mycoplasma and Ureplasma

Mycoplasma and ureaplasma are the smallest known microorganisms. It is among the sexually transmitted diseases. They are bacteria without cell walls. It causes pelvic inflammatory disease and bacterial vaginitis in women.

Mycoplasma hominis and Ureplasma urealiticum are opportunistic bacteria found in the lower urogenital system. There are normally a small amount of these bacterias in the urinary tract. However, their presence in higher quantities causes sexual transmission and disease.

Mycoplasma and ureaplasma can affect the pregnancy process by infecting chorionic villi in pregnant women.

Symptoms of this disease include:

  • Burning and pain in the urine,
  • Vaginal discharge,
  • Genital itching and burning,
  • Pain in the lower abdomen,
  • Painful sexual intercourse,
  • Unexplained infertility in men and women,
  • Recurrent pregnancy losses,
  • Flank pain due to the involvement of the kidneys,
  • Frequent urination, obstruction and pain while urinating in case of infection of the prostate gland
  • Rarely pain because of  testicular infection.

13. Hepatitis B and C

Hepatitis B and C are parenteral or sexually transmitted diseases. Transmission from mother to baby during pregnancy is the most important reason of chronic hepatitis B. The baby can get these viruses in the womb, at birth or after birth.

Acute hepatitis B infections in adults cure 95-99%. The disease is chronic infection in 1-5% of cases. The incidence of cirrhosis in chronic hepatitis B carriage over a 5-year period is approximately 10-20%. Hepatitis B is a virus that has a vaccine. All women of reproductive age can get this vaccine.

In hepatitis C disease, the situation is different. In 50% of people infected with hepatitis C, the disease progresses to chronic infection. Approximately 20% of these patients develop chronic active hepatitis or cirrhosis. Unlike hepatitis B, there is no vaccine to protect against this virus. Hepatitis C leads to acute hepatitis in pregnancy.

14. AIDS (HIV)

HIV (Human Immunodeficiency Virus, AIDS) is a disease transmitted through blood and unprotected sexual contact. It is an HIV-enveloped RNA virus that is not resistant to the external environment. It can be transmitted directly by blood donation, blood products, needle, surgical instruments, acupuncture, tattooing, tissue and organ transplantation, contact with injured parts and laserations in the skin and contact of menstrual blood to the penis during sexual intercourse.

During pregnancy, the virus can be passed to the baby in the womb, during or after birth. During breastfeeding, 30-40% of the virus is transmitted to the baby. In this case, the birth should be carried out by cesarean section and the mother should not breastfeed the baby after birth.

This virus mainly takes effect by destroying the CD4+ T cells of the immune system. As a result, many infections that can be treated under normal conditions become fatal in HIV-positive people.

There is no cure for HIV. However, the current use of antiretroviral therapies has allowed HIV-infected people to live a healthier and longer life.

GynecologistFunda Yazıcı Erol MDGynecology and Obstetrics
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